Referral Form

Date
REMINDER:

The Next Step for your client is to Book the Appointment

by visiting our website, www.vetsp.com
There is an option for the client to call 502-901-7990 to schedule the appointment, but the online portal is preferred. You may also complete this step for your client if you would like.
We are seeing cases in Evansville, IN and Louisville, KY!

Louisville appointments are available on Mondays and Tuesdays, and some Fridays. Appointments in Evansville are available every Wednesday and Thursday.
Please choose the location to which you are referring your patient: *
Patient Referral Form:
Patient's Name*
Patient Signalment. (F/FS/M/MN, Breed)*
Date of Birth*

MonthDayYear
Date
Weight*
In lbs
Primary Reason for Referral*
Referring Veterinarian*

First NameLast Name
Hospital Name*
Hospital Phone Number*

Area CodePhone Number
Veterinarian's Email*
example@example.com
Client's Full Name*

First NameLast Name
Co-Owner / Partner / Spouse

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Client's E-mail*
Date of Appointment if Already Scheduled

MonthDayYear
Date
Case Summary
Case History
Previous Diagnostics
Current Treatments (including drug name, dose, frequency)
Pending Lab Tests (Check all that apply)

CBC/ChemistryUrine cultureTick PCR / serologyOther
Behavior & Handling Notes: Does this patient have any behavioral concerns that our team should be aware of? (Select all that apply)*

No concerns – patient is calm and cooperativeMild anxiety (may need extra time or gentle handling)Fearful/defensive behavior (growling, hissing, snapping, swatting)Requires muzzle for safe handlingRequires pre-visit medications/sedationOther
You can upload files here, but we prefer to have DICOM radiographs sent via email to info@vetsp.com

Browse Files

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- You may schedule your client's appointment for them through the website (www.vetsp.com), or direct your clients to do so themselves.
- Appointments may also be scheduled by phone (502-901-7990)
- We will forward the discharge paperwork to you by the email listed above within 24 hours of the appointment
- Follow up labwork will be sent via email update when received and after the owner has been updated.
Should be Empty:

We are seeing cases in Evansville, IN and Louisville, KY!

Patient Referral Form:

Case Summary